Provider Demographics
NPI:1194953711
Name:DUSTRUDE, JOANNE S (RN)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:S
Last Name:DUSTRUDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 S JONATHAN LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7618
Mailing Address - Country:US
Mailing Address - Phone:414-425-2566
Mailing Address - Fax:
Practice Address - Street 1:4951 S JONATHAN LN
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7618
Practice Address - Country:US
Practice Address - Phone:414-425-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI88101163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health